Osteoarthrosis in type II diabetes mellitus, imaging approach. Number of cases / Osteoartrosis en diabetes mellitus tipo II, enfoque imagenológico. Serie de casos

Introduction: chronic non-communicable diseases such as diabetes mellitus have increased due to the increasing age of the population and the high prevalence of unhealthy lifestyles such as smoking, physical inactivity and poor dietary habits. Recently studies confirm that diabetes mellitus stimulates the early appearance of osteoarthritis in the body, also in the spinal column, leading to central canal stenosis; Low back pain is a frequent cause of a visit to the doctor. Case presentation: three patients with a long history of diabetes mellitus suffering from long-term low back pain to show the usefulness of imaging, nerve conduction, and laboratory tests as a tool in the differential diagnosis between osteoarthritis and noncompressive neuropathies. All cases have the lumbosacral region affected by osteoarthritis, especially by facet hypertrophy. Discussion: The symptoms and signs in our studied patients are caused by low back pain, cramps and numbness. All three patients had a history of type 2 diabetes mellitus and were obese or overweight. Individually, the older patient had good glycemic control based on the European Diabetes Guide, the younger patient had poor glycemic control, and one of them had associated chronic kidney disease. Conclusions: lumbar osteoarthritis with canal stenosis is a common cause of low back pain in our patients due to hypertrophy of the facet joint; therefore, we recommend imaging, nerve conduction, and physical examination as useful tools in the differential diagnosis between lumbar osteoarthritis and neuropathies due to type 2 diabetes mellitus. We suggest doing extensive research on the sign of early osteoarthritis in patients with diabetes mellitus in our facilities to increase the knowledge of this entity(EU)

Introducción: las enfermedades crónicas no trasmisibles como la diabetes mellitus se han incrementado debido al incremento de edad de la población y la alta prevalencia de estilos de vida no saludables como el hábito de fumar, inactividad física y pobres hábitos dietéticos. Recientemente estudios confirman que la diabetes mellitus estimula la temprana aparición de oosteoartrosis en el cuerpo, también en la columna vertebral, lidereando la estenosis del canal central; el dolor lumbar es una causa frecuente de visita al médico. Presentación de casos: tres pacientes con larga historia de diabetes mellitus que sufren dolor lumbar de larga data para mostrar la utilidad de las imágenes, la conducción nerviosa y las pruebas de laboratorio como herramienta en el diagnóstico diferencial entre osteoartritis y neuropatías no compresivas. Todos los casos tienen afectada la región lumbosacra por osteoartrosis, especialmente por hipertrofia facetaria. Discusión: los síntomas y signos en nuestros pacientes estudiados son causados por dolor lumbar, calambres y entumecimiento. Los tres pacientes tenían antecedentes de diabetes mellitus tipo 2 y obesidad o sobrepeso. Individualmente, el paciente de más edad tenía un buen control glucémico basado en la Guía Europea de Diabetes, el paciente más joven tenía un control glucémico deficiente y uno de ellos tenía una enfermedad renal crónica asociada. Conclusiones: la osteoartritis lumbar con estenosis del canal es una causa común de dolor lumbar en nuestros pacientes debido a la hipertrofia de la articulación facetaria; por lo tanto, recomendamos la imagen, la conducción nerviosa y el examen físico como herramientas útiles en el diagnóstico diferencial entre la osteoartritis lumbar y las neuropatías debidas a la diabetes mellitus tipo 2. Sugerimos hacer una amplia investigación sobre el signo de osteoartritis temprana en pacientes con diabetes mellitus en nuestras instalaciones para aumentar el conocimiento de esta entidad(AU)

Percutaneous Drainage of Chronic Destructive Lumbar Osteomyelitis Abscess Via the Use of Bilateral Transpedicular Trocar Access.

BACKGROUND: Pyogenic spondylodiskitis is an infection of intervertebral disks and spinal vertebral bodies. Various minimally invasive approaches to the infected disk spaces/abscesses have been described for management of early stages of the infection. Patients with chronic occurrence present with extensive infection, neurologic deficits, and bone destruction. Such patients commonly have substantial medical comorbidities. Despite the increased risks of complications, they often are treated with open surgical approaches without minimally invasive options. We describe a bilateral transpedicular approach to vertebral body abscess in a chronically infected patient with intraoperative contiguous irrigation. CASE DESCRIPTION: We present 2 cases, a 58-year-old man and a 61-year-old man, both with a diagnosis of vertebral osteomyelitis. Images of lumbar spine showed epidural abscess and adjacent vertebral body destruction. Because of their poor clinical condition and chronicity of disease, these patients underwent percutaneous bilateral transpedicular approach. CONCLUSION: Patients in poor health and with chronic vertebral osteomyelitis may benefit from minimally invasive percutaneous transpedicular drainage and irrigation of the abscess, representing a minimally invasive and effective treatment alternative for these patients.

Which Roland-Morris Disability Questionnaire? Rasch analysis of four different versions tested in a Norwegian population.

BACKGROUND: The Roland-Morris Disability Questionnaire (RDQ) is one of the most frequently used and recommended outcome measures for patients with low back pain. OBJECTIVE: To examine the fit of data from 4 different versions of the RDQ to a Rasch model in a Norwegian sample of patients with chronic low back pain and degenerative lumbar osteoarthritis. METHODS: Patients with chronic low back pain and degenerative lumbar osteoarthritis completed the RDQ prior to treatment in a secondary healthcare clinic. Data were analysed using a dichotomous Rasch model. RESULTS: Of 250 included patients, 243 patients with a mean age of 48.5 years completed all 24 items of the RDQ. None of the 4 RDQ versions (the original 24-item, the 18-item versions of Williams and Stratford, and the 11-item of Stroud) were a unidimensional measure of disability due to low back pain. Items 3 and 23 were redundant and items 13 and 18 did not fit the Rasch model. Several items showed differential item functioning, indicating that the items performed differently in subgroups of the sample. CONCLUSION: In the absence of consistent findings across studies that have evaluated the RDQ by Rasch analysis, caution should be exercised in the development and application of alternative versions of the RDQ.

Disfagia cricofaríngea en paciente con cervicalgia crónica / Cricopharyngeal dysphagia in patient with chronic cervicalgia

La acalasia o disfagia cricofaríngea se refiere al fracaso de apertura del esfínter esofágico superior (EES), que produce principalmente disfagia a sólidos, regurgitaciones y/o aspiraciones. Se diagnostica por esofagograma, videofluoroscopia (VDF) y manometría. El tratamiento mayoritariamente es quirúrgico. Se presenta a un paciente que acude a consultas de aparato locomotor aquejado de cervicalgia crónica y dificultad deglutoria, que inicialmente relacionamos con la presencia de osteofitos que improntan en el esófago en radiografía. Ante la persistencia de disfagia, se solicita tránsito de bario que descarta nuestra hipótesis y concluye con el diagnóstico de espasmo cricofaríngeo con presencia de divertículo. Se pretende evidenciar la importancia de que el médico rehabilitador, por su formación en diferentes disciplinas como la foniatría, deba tener una visión global del enfermo, sin límites exploratorios de cara a la obtención de datos relevantes para la orientación diagnóstica (AU)

Achalasia or cricopharyngeal dysphagia refers to the failure to open the upper esophageal sphincter (UES), mainly producing dysphagia to solids, regurgitations and/or aspirations. It is diagnosed by esophagogram, videofluoroscopy (VDF) and manometry. Treatment is mainly surgical. We report the case of a patient who came to the Locomotive System Unit, with complaints of chronic cervicalgia and difficulties in swallowing, which was initially associated to the presence of osteophytes observed in the esophagus X-ray. Due to the persistence of dysphagia, barium transit tests were carried out, ruling out our hypothesis. The diagnosis of cricopharyngeal spasms accompanied by diverticula was finally established. This study aims to show the importance for the rehabilitation medical specialist, trained in different disciplines such as phoniatry, to have a global vision of each patient, without imposing exploratory limitations in order to obtain relevant data in the diagnostic approach (AU)

[Effective pain relief facilitates exercise therapy : Results of a multicenter study with controlled-release oxycodone in patients with movement pain]. / Effektive Schmerzlinderung ermöglicht Bewegungstherapie : Ergebnisse einer Multicenterstudie mit retardiertem Oxycodon bei Patienten mit Bewegungsschmerz.

BACKGROUND: The efficacy and tolerability of oral controlled-release oxycodone in the therapy of musculoskeletal pain were analyzed in this observational study. PATIENTS AND METHODS: A total of 843 patients with severe to most severe pain in the musculoskeletal system were treated with controlled-released oxycodone for 4 weeks or up to a maximum of 6 months. Severity of pain, impairment in quality of life, and mobility associated with the pain were assessed before and during therapy with controlled-release oxycodone by a numerical rating scale (NRS 0-10). RESULTS: Pain intensity fell by an average of 65% within the first 4 weeks. Physical therapy was practicable in many patients only after implementation of a therapy regime with controlled-release oxycodone. Quality of life improved significantly under therapy with oxycodone, and the impairment of different aspects of life decreased by 50%. CONCLUSION: The therapy of pain of the musculoskeletal system with controlled-release oxycodone is efficient. An effective pain relief makes physical therapy practicable, reduces the impairment in different parts of life, and increases quality of life.